HomeMy WebLinkAboutdata request OROPIO ADMINIS�RATIVE OFFI�S
INFORMATION DISCI�OSTTRE REQIIEST
MINNESOTA Ga DATA PR�CTICES ACT
' gEQDESTF.R NOTE:
A, Request Freauency - Private Data on individuals. After you
have been supp lied the data and inf ormed of its meaning,
the
data need not be disclosed to yendinq or additional edatat�on
unless a dispute or ac�ion is p
you has been collected.
B , you may be required to pay actual costs in making,
certifying and/or comailing the copies oz inforazation
requested. -
I � ��.- q�'
Date of Request:
. . 1 {/,
Requester Name:
Address: (p �O .°I.�p L-�Q. City: v
Z ip: � J ��O �'"
gome Phones
[,� � �-.- L..� -�,- ,�j � Business:
���i�'��� �. �-�^.-.r.a.d
Description of Information R ested: P� � �
�
�_
��' .... �^_�,
Requester' s Signature:
BELOW INFORM�TION TO BE FILLED IN BY DEPARTMF?t7T ONLY
� � 2 Eanaled By: -'� -
Department:
In erson Mai1. Phone
gequest Type: _� P
gequested By: Subjec� o= Data
p< Not Sub j ect of Data
Information Re�quested is Classified: 0�
�ublic Private
Confidential Non-�ublic =rotected Non-Publ.ic
gequest is:
�pproved Denied Anproved in Part
Remarks/Co�ents_
Authorized Signature"
_ $
Fees:� x Total Due
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